MEDICARE: MRS. CARRIE JEAN-BOROWSKI BOLLMANN FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	4704177269	MI

General Provider Information

NPI Number	:	1417935040
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CARRIE JEAN-BOROWSKI BOLLMANN FNP-C

Provider Business Mailing Address
First Line	:	1249 M-75 SOUTH
Second Line	:
City	:	BOYNE CITY
State	:	MI
Zip	:	49712
Country	:	US
Telephone Number	:	231-582-1515
Fax Number	:	231-582-2425

Provider Business Practice Location Address
First Line	:	1249 M-75 SOUTH
Second Line	:
City	:	BOYNE CITY
State	:	MI
Zip	:	49712
Country	:	US
Telephone Number	:	231-582-1515
Fax Number	:	231-582-2425

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/04/2006
Last Update Date	:	11/30/2018

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